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NAPLEX Prep > CV drugs > Flashcards

CV drugs Flashcards

1
Q

G PACMAN

A

CYP3A4 inhibitors that interact with simvastatin & lovastatin:

Grapefruit

Protease inhibitors
Azole antifungals
Cyclosporine, cobicistat
Macrolides (except azithromycin)
Amiodarone
Non-DHP CCB’s (dilt, verap)

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2
Q

Nitro-Bid

A

Long acting nitrate
Nitroglycerin ointment 2%
Admin: dosed BID 6 hrs apart w/ 10-12 hr nitrate-free interval

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3
Q

Thalitone

A

Thiazide diuretic
Chlorthalidone

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4
Q

MONA-GAP-BA
M

A

Morphine sulfate -> pain relief
reserved for unacceptable pain/discomfort
has been shown to diminish antiplatelet effects
Dose: 2-5mg IV Q5-30min PRN

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5
Q

Beta Blockers: Beta 1 selective agent characteristics

A

Boxed warning: do not DC abruptly
CI: severe bradycardia, AV block
Warnings:
- can worsen hyper or hypoglycemia & mask hypoglycemic sx in diabetic pts
- caution in asthma/COPD (bronchospasm)
ADE:
- Bradycardia
- Fatigue/Depression
- Hypotension
- Impotence
- can exacerbate Raynaud’s (cold extremities)

Notes:
- beta 1 selective agents safest BB for asthma/COPD
- take without regard to food (except metoprolol -> take with food)
- Metoprolol tartrate IV: PO = 1:2.5

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6
Q

Simvastatin 10mg

A

Low intensity

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7
Q

How long after PDE-5i’s can nitrates be given?

A

Avanafil (Stendra): 12hrs
Sildenafil (Viagra): 24hrs
Vardenafil: 24hrs
Tadalafil (Cialis): 48hrs

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8
Q

Vasotec IV

A

ACEi
Enalaprilat

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9
Q

DHP CCB class characteristics

A

MOA: inhibit Ca ions from entering vascular smooth muscle & myocardial cells -> peripheral arterial vasodilation -> decreased systemic resistance (SVR) & BP
Warnings:
- Hypotension
- do not use nifedipine IR for chronic or acute BP reduction in non-pregnant adults -> profound hypotension, MI, death
ADE:
- Tachycardia/palpitations
- HA
- flushing
- peripheral edema
- gingival hyperplasia (less than Non DHP)
Notes:
- used to prevent Raynaud’s (cold, blue fingers)

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10
Q

Fibrinolytic characteristics

A

CI:
- active bleed
- recent stroke
- severe uncontrolled HTN
ADE: bleeding
Monitor:
- Hgb
- Hct
- signs of bleeding

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11
Q

Integrilin

A

GP 2b/3b RA
Eptifibatide
ADE: bleeding, thrombocytopenia

reversible blockade- platelet function recovers in 4-8hrs

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12
Q

Lovastatin 20mg

A

Low intensity

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13
Q

Inspra

A

K sparing diuretic
Eplerenone

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14
Q

Non-DHP CCB class characteristics

A

MOA: same as DHP CCB’s but selective for myocardial tissue
Use: control HR in certain arrhythmias
- sometimes also used for HTN & angina
Warnings:
- may worsen HF symptoms
- bradycardia
ADE:
- edema
- constipation
- gingival hyperplasia

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15
Q

Cardizem, Tiazac

A

Non-DHP CCBs
Diltiazem

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16
Q

Ziac

A

Bisoprolol/HCTZ

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17
Q

Calan SR

A

Non-DHP CCB
Verapamil

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18
Q

Beta Blockers: Beta 1 selective agents

A

Atenolol (Tenormin)
Esmolol (Brevibolc)
Metoprolol Tartrate (Lopressor)
Metoprolol Succinate ER (Toprol XL)

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19
Q

Zestril, Prinivil

A

ACEi
Lisinopril

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20
Q

Avapro

A

ARB
Irbesartan

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21
Q

Toprol XL

A

Beta 1 selective BB
Metoprolol succinate ER

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22
Q

Lipitor

A

Atorvastatin

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23
Q

Coreg

A

Nonselective BB & alpha-1 blocker
Carvedilol

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24
Q

Fluvastatin 20-40mg

A

Low intensity

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25
Q

Hyzaar

A

Losartan/HCTZ

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26
Q

Atorvastatin 40-80 mg

A

High intensity

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27
Q

Statins: lipid panel monitoring

A

lipid panel @ baseline, 4-12 weeks after initiation, yearly thereafter

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28
Q

Benicar HCT

A

Olmesartan/HCTZ

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29
Q

Exforgel

A

Valsartan/Amlodipine

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30
Q

MONA-GAP-BA
A (MONA)

A

Aspirin
Non-enteric coated, chewable ASA 162-325mg immediately

maintenance dose 81-162 daily indefinitely

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31
Q

Effient Dosing

A

LD: 60mg PO
MD: 10 mg PO daily

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32
Q

Effient

A

P2Y12
Prasugrel
BW: BLEEDING
- not recommended in pts > 75
- stop at least 7 days prior to surgery
- avoid use if CABG likely
CI:
- active bleed
- hx of TIA or stroke
Warnings:
- bleed risk
- TTP
ADE: bleed
Notes:
- Only indicated for ACS managed with PCI
- Dispense in original container

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33
Q

Rosuvastatin 5-10 mg

A

Moderate intensity

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34
Q

Simvastatin 20-40mg

A

Moderate intenstiy

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35
Q

Beta 1 selective agent w/ NO dependent vasodilation
- agent
- characteristics

A

Nebivolol (Bystolic)
Same as other beta1 selective agents PLUS
- contraindicated in severe liver impairment
- ADE: nausea, inc TGs, dec HDL

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36
Q

Benicar

A

ARB
Olmesartan

sprue-like enteropathy: severe, chronic diarrhea w/ substantial weight loss; can occur months-years after initiation

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37
Q

Brillinta

A

P2Y12
Ticagrelor
BW:
- bleeding
- do not exceed 100mg ASA daily d/t reduced ticagrelor effectiveness
- avoid use if CABG likely
- stop 5 days before surgery
CI:
- active bleed
- Hx of intracranial hemorrhage
Warnings:
- bleed risk
- TTP
ADE:
- bleeding
- dyspnea

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38
Q

Which statins have fewer DDI

A

Rosuvastatin
Pravastatin

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39
Q

Plavix Dosing

A

LD: 300-600 mg PO
- 600 for PCI

MD: 75 mg PO daily

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40
Q

Adalat CCB, Procardia XL

A

DHP CCB
Nifedipine ER

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41
Q

Diovan HCT

A

Valsartan/HCTZ

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42
Q

Welchol

A

Colesevelam
Bile acid sequestrant
CI: bowel obstruction
ADE: constipation, ABD pain, bloating, gas, inc TG

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43
Q

NitroMist, Nitrolingual

A

Short acting nitrate
Nitroglycerin TL spray

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44
Q

Potassium Sparing Diuretic Class Characteristics

A

MOA: compete with aldosterone at receptors in the nephron -> inc excretion of Na and water while conserving K
CI:
- hyperkalemia
- severe renal disease
ADE:
- hyperkalemia
- increased SCr
- Dizziness
DDI:
- can decrease Li clearance -> toxicity

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45
Q

Beta Blocker MOA

A

MOA: competitively block beta 1 and/or beta 2 adrenergic receptors -> decreased HR and myocardial contractility

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46
Q

Bystolic

A

Beta 1 selective BB w/ NO dependent vasodilation
Nebivolol

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47
Q

Vasotec

A

ACEi
Enalapril

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48
Q

MONA-GAP-BA
O

A

Oxygen
indicated for patients w/ SaO2 sat < 90% & pts in respiratory distress

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49
Q

Statin equivalent doses

A

Remember: Pharmacists Rock AT Saving Lives and PReventing Fatty Deposits

Pitavastatin: 2mg
Rosuvastatin: 5 mg
Atorvastatin: 10mg
Simvastatin: 20mg
Lovastatin: 40mg
Pravastatin: 40mg
Fluvastatin: 80mg

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50
Q

HTN Classification:
SBP 130-139 OR DBP 80-89

A

Stage 1 HTN

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51
Q

Pravachol

A

Pravastatin

52
Q

G PACMAN

A

Significant CYP3A4 inhibitor DDI with simvastatin & lovastatin
- Grapefruit

  • Protease inhibitors (CI)
  • Azole antifungals (CI)
  • Cyclosporine, Cobicistat (alt -> Ros, Ato respectively)
  • Macrolides, except azithromycin (CI)
  • Amiodarone (caution)
  • Non-DHP CCBs (decrease dose)
53
Q

Zetia

A

Ezetimibe
inhibits cholesterol absorption
ADE: myalgia
Lipid effects:
- dec LDL 18-23%

54
Q

Aldactone

A

K sparing diuretic
Spironolactone

Unique characteristics:
- blocks androgen -> endocrine ADEs
- CI: Addison’s disease (adrenal insufficiency)
- ADE: gynecomastia, breast tenderness, impotence

55
Q

MONA-GAP-BA
G

A

GP 2b/3a RAs
Eptifibatide
Tirofiban

56
Q

Lopressor

A

Beta 1 selective BB
Metoprolol Tartrate

57
Q

Statin lipid effects

A

decrease LDL ~ 20-55%
decrease TG ~ 10-30%
increase HDL ~ 5-15%

58
Q

Drugs that increase BP

A

Amphetamines & ADHD meds
Cocaine
Decongestants (pseudoephedrine, phenylephrine)
ESAs
Immunosuppressants (cyclosporine)
NSAIDs
Systemic steroids

59
Q

Lotrel

A

Benazepril/Amlodipine

60
Q

Activase

A

Fibrinolytic
Alteplase
MOA: tissue plasminogen activator

61
Q

ACE inhibitor class characteristics

A

MOA: block conversion of angiotensin I to angiotensin II -> dec vasoconstriction & aldosterone secretion
Boxed Warning:
- do not use in pregnancy (teratogenic)
Contraindications:
- Hx of angioedema with RAASi use
- do not use within 36h of Entresto
Warnings:
- angioedema
- hyperkalemia
ADE:
- cough
- hyperkalemia
- inc SCr
- hypotension

62
Q

MONA-GAP-BA
P

A

P2Y12 inhibitors
Clopidogrel
Prasugrel
Ticagrelor

63
Q

Zocor

A

Simvastatin

64
Q

Plavix

A

P2Y12
Clopidogrel
BW: test for CYP2C19 genotype (poor metabolizers will not see full effectiveness from this prodrug)
CI: active bleed
Warnings:
- bleed risk (stop 5d before planned surgery)
- do not use with omeprazole or esomeprazole
- Thrombotic thrombocytopenic purpura (TTP)
ADE:
- bleed risk

65
Q

Tenormin

A

Beta 1 selective BB
Atenolol

66
Q

Non-selective beta blockers

A

Propranolol (Inderal)
Nadolol (Corgard)
Same characteristics as B1 blockers PLUS
- additional use: portal hypertension
- not preferred in asthma / COPD

67
Q

ARB class characteristics

A

MOA: block angiotensin II from binding to receptors on vascular smooth muscle -> prevents vasoconstriction
Safety/ADE/Warnings same as ACE’s except:
- Less cough
- less angioedema
- no washout period with Entresto

68
Q

Inderal

A

Nonselective BB
Propranolol

69
Q

Statins that should be taken in the evening

A

Fluvastatin IR
Lovastatin (Altoprev) XR
Simvastatin (Zocor)

70
Q

Ranexa

A

Anti-anginal agent
Ranolazine
Use: substitute for or addition to BB in SIHD maintenance treatment
CI: strong CYP3A4 inhibitors/inducers
Warnings:
- QT prolongation
- acute renal failure when CrCl < 30
ADE: dizziness, HA, constipation, nausea
Notes: not for acute treatment of chest pain

71
Q

Rosuvastatin 20-40 mg

A

High intensity

72
Q

Zestoretic

A

Lisinopril/HCTZ

73
Q

Aquazide H, Hydrocot

A

Thiazide diuretic
Hydrochlorothiazide

74
Q

Lotensin

A

ACEi
Benazepril

75
Q

Fluvastatin 40 mg BID / 80mg XL

A

Moderate intensity

76
Q

Lovaza

A

Omega 3 Acid Ethyl Esters
Fish oil
Warning: caution with hx of HSR to fish or shellfish
ADE: burping, dyspepsia, taste perversion, inc bleed risk
Lipid effects:
- Dec TG up to 45%
- can inc LDL up to 44%

77
Q

Trandate

A

Nonselective BB & alpha-1 blockers
Labetalol
preferred agent in pregnancy

78
Q

Brevibloc

A

Beta 1 selective BB
Esmolol
injection only

79
Q

HTN Classification:
SBP > 140 OR DBP > 90

A

Stage 2 HTN

80
Q

Niacor, Niaspan

A

Niacin (aka nicotinic acid, vit B3)
Warnings
- rhabdomyolysis
- hepatotoxicity
- Lab abnormalities (inc BG & uric acid)
ADE:
- flushing
- pruritus (itching)
- vomiting
- diarrhea
- hyperglycemia
- gout
Admin: take with food
ER formulation (Niaspan) preferred due to less flushing & hepatotoxicity
Lipid effects:
- inc HDL~15-35%

81
Q

Norvasc

A

DHP CCB
Amlodipine

Safest CCB in HFrEF if one must be used

82
Q

Statin contraindications

A

breast feeding
liver disease
concurrent use of strong CYP3A4 inhibitors (simva & lova)

83
Q

Repatha

A

Evolocumab
PCSK9i
Admin: SC every 2 weeks or monthly
ADE: injection site reactions
Lipid effects:
- dec LDL ~ 60%

84
Q

Isordil Titradose

A

Long acting nitrate
Isosorbide dinitrate

85
Q

Statin ADE

A

myalgia/myopathy
hepatotoxicity

86
Q

Lovastatin 40 mg

A

Moderate intensity

87
Q

Isodur

A

Long acting nitrate
Isosorbide mononitrate

IR tab: dosed BID, 7 hrs apart

ER tab: daily AM dosing

88
Q

HTN Classification:
SBP < 120 AND DBP < 80

A

Normal

89
Q

Cardene IV

A

DHP CCB
Nicardipine

90
Q

Lopid

A

Gemfibrozil
Class: Fibrate
CI: severe liver disease, gallbladder disease
Warnings: inc risk of myopathy when taken with statins
ADE:
- Dyspepsia
- inc LFTs (dose related)
DDI:
- can inc effects of sulfonylureas and warfarin
Lipid effects:
- dec TG ~20-50%
- can inc LDL when TG are high

91
Q

Nitroglycerin clinical characteristics

A

CI: do not use with PDE-5i’s
ADE:
- HA
- flushing
- syncope
- hypotension/dizziness

92
Q

Praluent

A

Alirocumab
PCSK9i
Admin: SC every 2 weeks or monthly
ADE: injection site reactions
Lipid effects:
- dec LDL ~ 60%

93
Q

MONA-GAP-BA
B

A

Beta blockers
Metoprolol or carvedilol preferred

contraindications:
- decompensated HF
- cardiogenic shock
- HR < 45 bpm

94
Q

MONA-GAP-BA
A (GAP)

A

Anticoagulants
LMWH (enoxaparin, dalteparin)
UFH
Bivaliruden

UFH & Bivaliruden preferred in STEMI

95
Q

MONA-GAP-BA
N

A

Nitrates
0.4mg SL NTG every 5 minutes x 3 doses

if symptoms persist -> IV NTG
Do not use IV NTG if:
- SBP < 90 mmHg
- HR < 50 bpm
- PDE-5 inhibitor use

96
Q

HTN treatment in pregnant patients

A

Preferred drugs:
- Labetalol
- Nifedipine ER

Avoid:
- ACEs & ARBs

Preeclampsia:
- daily low dose ASA after 1st trimester in high risk pts (prior HTN, renal disease, diabetes)

97
Q

Cozaar

A

ARB
Losartan

98
Q

Vascepa

A

Icosapent ethyl
Fish oil
Warning: caution with hx of HSR to fish or shellfish
ADE: burping, dyspepsia, taste perversion, inc bleed risk
Admin: take with food
Lipid effects:
- Dec TG up to 45%
- DOES NOT inc LDL

99
Q

Beta blocker DDIs

A
  • enhance hypoglycemic effects of insulin & SU’s
  • caution with other drugs that lower HR (diltiazem, verapamil, digoxin, clonidine, amiodarone)
100
Q

Maxzide

A

Triamterene/HCTZ

(K sparing / Thiazide diuretic)

101
Q

Nitrostat

A

Short acting nitrate:
Nitroglycerin SL tablets
Store in original amber glass bottle

102
Q

Non-selective BB & alpha 1 blockers

A

Carvedilol (Coreg)
Labetalol (Trandate)
Same as B1 selective agents PLUS
- CI: severe hepatic impairment
- Warning: intraoperative floppy iris syndrome
- ADE: edema, weight gain
Notes
- take carvedilol with food to decrease rate of absorption -> less ortho hypo

103
Q

ReoPro

A

GP 2b/3a RA
Abciximab
ADE: bleeding, thrombocytopenia

irreversible blockade- platelet function recovers in 24-48 hrs

only recommended in ACS patients receiving PCI +/- stent

104
Q

Aggrastat

A

GP 2b/3b RA
Tirofiban
ADE: bleeding, thrombocytopenia

reversible blockade- platelet function recovers in 4-8hrs

105
Q

GoNitro

A

Short acting nitrate
Nitroglycerin SL powder

106
Q

Statin Warnings

A

Higher risk for muscle damage with:
- high dose
- old age
- + niacin, gemfibrozil, or CYP3A4 inhibitor
Diabetes:
- may increase A1C & fasting glucose

107
Q

TNKase

A

Fibrinolytic
Tenecteplase

108
Q

Corgard

A

Nonselective BB
Nadolol

109
Q

Tenoretic

A

Atenolol/Chlorthalidone

110
Q

Carvedilol ER:IR conversion

A

3.125mg IR = 10mg ER

111
Q

Altoprev

A

Lovastatin

112
Q

Nitro-Dur

A

Long acting nitrate
Nitroglycerin transdermal patch
Admin: wear for 12-14hrs, off for 10-12hrs; rotate sites

113
Q

Preferred stable angina maintenance treatment in HFrEF

A

Isosorbide dinitrate + Hydralazine

114
Q

Accupril

A

ACEi
Quinapril

115
Q

Long acting nitrates notes

A

Require a 10-12 hr nitrate-free interval to reduce tolerance

Patch: wear for 12-14hrs, off for 10-12hrs; rotate sites

Ointment: dosed BID 6 hrs apart w/ 10-12 hr nitrate-free interval

116
Q

Pravastatin 10-20mg

A

Low intensity

117
Q

Antara, Tricor, Trilipix

A

Fenofibrate, Fenofibric Acid
Class: Fibrate
CI: severe liver disease, gallbladder disease
Warnings: inc risk of myopathy when taken with statins
ADE: inc LFTs (dose related)
DDI:
- can inc effects of sulfonylureas & warfarin
Lipid effects:
- dec TG ~20-50%
- can inc LDL when TG are high

118
Q

Crestor

A

Rosuvastatin

119
Q

Altace

A

ACEi
Ramipril

120
Q

Pravastatin 40-80 mg

A

Moderate intensity

121
Q

Pitavastatin 1-4mg

A

Moderate intensity

122
Q

Calcium Channel Blocker DDIs

A
  • Caution with other drugs that reduce HR (BB, digoxin, clonidine, amiodarone)
  • CCBs are major substrates of CYP3A4, caution with strong inducers & inhibitors
  • NDHP CCBs can reduce lovastatin & simvastatin metabolism
123
Q

MONA-GAP-BA
A (BA)

A

ACE inhibitor
start within first 24hrs & continue indefinitely in pts w/ LVEF < 40%, HTN, diabetes, or stable CKD.

use ARB if pt is ACE intolerant

do not use IV ACE within the first 24 hrs due to risk of hypotension

124
Q

HTN Classification:
SBP 120-129 AND DBP < 80

A

Elevated BP

125
Q

Brilinta Dosing

A

LD: 180 mg PO
MD: 90mg PO BID x 1 year then 60mg PO BID

126
Q

Atorvastatin 10-20 mg

A

Moderate intensity

127
Q

Thiazide diuretic class characteristics

A

MOA: inhibit Na reabsorption in the distal convoluted tubule -> inc excretion of Na, Cl, K, and water
CI: sulfonamide allergy
ADE:
- Decreased K, Mg, Na
- Increased Ca, UA, LDL, TG, BG
DDI:
- NSAIDs decrease thiazide effectiveness (water retention)
- Thiazides decrease Li clearance -> toxicity
- not effective in CrCl < 30
- take in AM to avoid nocturia

NAPLEX Prep (40 decks)

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